Should all prescription drugs by made over-the-counter?

[zoidberg]

I've got drugs on my mind today. :)

One of the more interesting libertarian suggestions for reducing the high costs of prescription drugs is to end the monopoly that doctors and pharmacies have in distributing them. Costs are prices are dramatically increased because of the layers needed to get a prescription drug. The doctor takes his cut and the pharmacist takes his cut. Everytime a prescription drug begins to be sold over the counter, the price drops dramatically. So why not let all prescription drugs by sold over the counter (or over the internet)? If you are in favor of legalizing recreational drugs, what objection could there be to legalizing medicinal drugs? If you are worried about health, you still have the right to go to the doctor and get a recommendation. It's a screwy idea, but I'd like to hear some ideas about it.

[Kamika]

1. ok..

I dont think this would work.

Ppl would sell to junkies.. friends.. take some for the saturday party..

Wouldnt work.

[zoidberg]

4. So should hard drug remain illegal?

If so, then you make a very good point that would be enough to make this a bad idea. If not, then what is the difference between abusing heroin and abusing any other drug?

[Kamika]

13. Yeah

Ofcourse i think "hard" drugs shall be illegal

[shockandawed]

18. The difference is huge!!!!!!!!!!!!!!

The main difference is that prescription drugs can be had usually without dealing with an international crime syndicate, and all of the hazards involved in being a drug purchaser. Drug potency among hard drugs is the leading cause of drug related deaths, something that would not concern professionally manufactured drugs. This is a poor argument at best, especially since hard drugs have minimal therapeutic value in their street form.

[slappypan]

2. What about overuse of anti-biotics?

Uncontrolled use of anti-biotics destroys their effectiveness and create virulent drug-resistant pathogens.

[MaverickX]

3. no...

Unless each of us have a medical degree how in the heck are we supposed to know how much of a medicine to take or even what medicine. Libertarians will say its their body and their risk to take but does that mean we shouldn't have safety inspections on food, automobiles, and other consumer products? However with medication you'd also need some kind of medical expertise to make an informed decision.

[zoidberg]

9. So should over-the-counter drugs be made prescription then?

How am I supposed to know how much aspirin to take for my headache? I might mix the wrong drugs and kill myself. There are plenty of ways to make informed decisions without going to the doctor. I had strep throat just about every year in college. Every year the clinic would prescribe amoxicillin. What would be wrong with me cutting out the middleman and going straight to the internet and buying the medicine?

[shockandawed]

19. You might

what you may not realize is that reactions to medications is consistently in the top five reasons for ER visits. And this is in a situation where only the safest medications are available over the counter. Imagine the ER floods when all medications would be available over the counter.

[MaverickX]

20. the instructions for taking aspirin are very general...s

But if you take too much penicillin for your body weight you could go into a coma or die. Aspirin is alot more general, hence it's over the counter. I don't get your story though, which middleman are you talking about? You had a prescription so why couldn't you get the medication? Is going to a drugstore that difficult?

[bearfartinthewoods]

31. if you overuse asporin, you don't endanger anyone's life but your own

if people, through improper use of anti-biotics, breed more and more antibiotic resistant bacteria, we are all screwed right back to the 1800's.

[cjbuchanan]

5. Bad idea

There are people who would misuse the system and self-medicate. I feel a little depressed, got to buy my Prozac. Also, imagine how many teenage boys would buy Viagra just to see what happens.

[sendero]

35. hate to tell ya...

... but as far as I can tell ANYONE at ANY TIME can ask their family physician for an SSRI drug and get it. It is not like there is any regulation on that at all.

That does not mean I totally agree with the proposition at hand. But it is my undertanding that in Japan most drugs can be purchased over the counter.

[quilp]

6. HMOs would love it. They only pay for prescription drugs.

n/t

[ewagner]

8. Absolutely right

they would dance in the streets just like they did when Clariten (spelling) went over-the-counter.

[slackmaster]

7. No, many of them require specialized knowledge or are addicting

I can't see selling morphine over the counter, or antibiotics.

If you are in favor of legalizing recreational drugs, what objection could there be to legalizing medicinal drugs?

Let's talk narcotics for a moment. I am in favor of allowing people to grow and use their own opium, which is a naturally occurring substance and has been cultivated by people for thousands of years. Refined and chemically altered products like morphine and heroin have far more potential for addiction. Some people can use them and remain functional, but not everyone.

http://www.poppies.org

[zoidberg]

11. You set a good standard for drug legalization

I kind of like your idea. If you can grow it, you can use it. Are you saying heroin should still be illegal?

I'm kind of torn on legalizing many chemically altered drugs. The current policies might be doing more harm than good, but I don't know if legalization is the answer.

If you are in favor of some restriction of drug use, then it is very consistant and logical to not like the idea of all drugs being over-the-counter.

[slackmaster]

15. I think COMMERCE in heroin should be illegal

I support the "home is castle" principle. If you can grow poppies and make your own heroin and use it at home I don't have a problem with it. If I catch you selling it to school children and you're dead meat.

[Snow]

30. This poses a difficulty in terms of class distinctions -

people without land are left out of this. Renters, and the like.

[slackmaster]

43. They can't grow their own tomatoes either

:shrug:

I'm not opposed to commerce in raw opium.

[shimmergal]

10. Not sure.

I think we should separate out those that are "prescription only" because they really need medical oversight, from those kept on this basis simply to maximize profits.

And BTW, you _can_ buy personal orders of many prescription drugs from European and Mexican pharmacies through the Internet, without a prescription. Even with the shipping costs they're usually less than the whole process of getting them in the U.S.A. involves. Can't do it with drugs that you need right away though (shippping takes at least 2-3 weeks) or with those restricted because of their psy effects, like Demerol.

[glarius]

12. Why not just have gov't price controls on them like in Canada?

The drug companies would then make a GOOD profit on their products...not an ASTRONOMICAL profit as they do now in the States....My husband takes 7 daily prescriptions and I take 4....If we were American we could probably not afford them....:)

[shockandawed]

14. Are you insane??

I agree with releasing those with proven safety, but there are a couple of huge problems with this idea, and I think you have fallen for insurance company propaganda rather than a libertarian idea.

Problem 1 - Drug interaction. MANY medications cause reactions when mixed, including when the most common anti depressant and common pain relievers are taken together. Many others require supervision of a doctor to monitor for drug side effects. And many other medications will kill or cause enormous damage if it was not the medication someone needed.

Problem 2 - This 'plan' is a scam floated by insurance companies. Note that in the past 24 months, claritin went over the counter. The manufacturer objected, but this was pushed by insurance as a cost savings measure. This is a shortsighted plan championed by insurance companies wanting to make this year's income forcast. So many injuries would result (not to mention addictions)that the costs would obliterate any savings.

Problem 3 - This plan actually screws the middle class. Insurers will no longer cover any medications if this were to come about. This will cost Americans more, not less. Claritin users are actually paying MORE as a result of the medication being offered over the counter, because their insurance covers none of it. And who benefits? The retail chain, who sells the generic without ever investing a penny in research to develop a drug, and the insurance company, who only had to lobby for its members to pay for their own medications.

You have been fooled. This is a piss poor idea. The strategy should be to vigorously defend the laws stating when the patent expires so generics can reduce the cost while still providing the safeguards of the prescription system. Companies presently manipulate patent law to extend their exclusive rights to produce this medicine, such as all of the incarnations of Paxil, etc.

[FlaGranny]

25. Excellent summary

of the problems involved, shockandawed. I was going to post something similar.

PS: Welcome.

[DavidMS]

16. I don't think it would work...

however compulsory licencing of drugs to manufauctures and limits on pattent leinght would help. Of cource banning adertising of perscription drugs to non-doctors would also cut costs. Perhapse medical devices should have their pattents protections reduced also?

[Hasaler]

17. I don't think so.

People have a tendency to believe that if a little is good, more is better. There is already too much abuse of these drugs. As an example, someone not knowing any better could take too much of a drug for hypertension (high blood pressure) and end up killing themself. Kava kava, an herbal remedy, can cause liver damage, but probably because of overuse. Taken responsibly, it can be safe. Even Tylenol can kill someone over time if it is not used responsibly.

On the other hand, there are some drugs for prescription right now that could be converted to over the counter.

[KamaAina]

39. Liver damage has been traced to improperly made kava kava supplements

The subject is of considerable interest here, since the plant Hawaiians call 'awa was just emerging as a potential export crop for us when the scare stories hit.

How, you ask, did a plant that's been used safely throughout the Pacific for centuries suddenly become mega-toxic?

http://the.honoluluadvertiser.com/article/2003/Apr/07/ln/ln03a.html

Now researchers led by Tang believe they may have found the key: Peelings from the stem bark of kava plants apparently were used to create the extract for the herbal supplements, and may be to blame for liver failure and liver-related injuries that included hepatitis and cirrhosis.

Traditional kava drinkers discard the peelings, but Tang and his team learned from a trader in Fijian kava that European pharmaceutical companies eagerly bought up the peelings when demand for kava extract soared in Europe in 2000 and 2001....

Preliminary tests by researcher Pratibha Nerurkar show pipermethystine has a "strong negative effect" on liver cell cultures. If peelings containing the alkaloid were used to make kava capsules — and the scientists suspect they were — that could explain the liver damage in some of the people who took the capsules....

The Fijian kava dealer reported the peelings had emerged as a very important trading item because "it's cheap and it's a waste product by the kava drinkers, therefore the pharmaceutical companies, they love it and it became part of the trade," Tang said.

Thanks a lot, greedheads! You not only poisoned people back in Europe, you squashed one of our most promising efforts to re-use our abandoned sugarcane fields (abandoned because of -- you guessed it -- corporate greed!).

The good news is that IF you can find a kava kava supplement made with the root, the whole root, and nothing but the root :-) , it will be safe.

[denverbill]

21. Absolutely not. Antibiotic abuse is a very BAD thing.

How many people would routinely pops antibiotics every time they got a cold if they could walk into the Walgreens and buy them?

That's how drug resistant organisms gain their drug resistance.

[Lydia Leftcoast]

28. A lot of medically naive people would pop antibiotics

at the slightest sign of a sniffle.

The problems we're having with drug-resistant bacteria comes from two sources: 1) farmers giving antibiotics to healthy animals to make them grow faster, a practice that should be outlawed, and 2) foreign countries where antibiotics are available OTC to anyone who asks, and the stupid Americans who go there, buy them, and misuse them.

In addition, drug interactions can literally kill people. No responsible doctor will prescribe a medication without first finding out what. if any, other meds the patient is currently taking.

Even single drugs can cause fatal side effects in certain people. That's why people on strong medications have to be monitored and their dosage adjusted accordingly if they start having strange symptoms.

[Brian Sweat]

22. The high cost of prescription drugs has nothing to do with the fact

that you need a prescription to get them. I need a prescription to get generic thyroid hormone replacement medicine, but the cost of this medicine is very comparable to OTC drugs.



Doctors tend to proscribe the latest drugs that are still under patent by the Big Pharma companies that develope them. Big Pharma charges a hefty premium for drugs that are still protected by patents. Often, these new drugs work in the exact same say as existing drugs that are no longer protected by patents. Doctors don't know this, because Big Pharma spends a lot of money to pull the wool over their eyes.

Big Pharma wants us to believe that the high cost of these new drugs is because they have to spend so much to develope them, but the truth is that they spend over twice as much on advertising as they do on developement.

Big Pharma also wants us to believe that if the drugs they developed were not protected by patents (drug patents last longer than other patents), that there would be no incentive for them to develope new drugs. The truth is that most of Big Pharma's research money go into developing new version of old drugs that do the exact same thing. Big Pharma can not make lots of money on rare deseases and they cannot make money on drugs that are no longer protected by patents, but they can make huge stacks on new (patent protected) versions of existing types of drugs if they can convince Doctors and patients that these are the drugs that they need.

This is one area where the free market simply doesn't work. We are giving Big Pharma billions of dollars every year to pay for advertising and research for drugs like Celebrex which is no more effective than current OTC analgesics. Research and development of new drugs should be paid for and overseen by the government and the drug companies should just manufacture the drugs without the benefit of patents.

[SharonAnn]

23. No, the recent experience with Claritin shows that the price

doesn't go down and many people pay more because their prescription drug plan no longers pays for part of it. For those who didn't have prescription drug coverage, the price didn't change.

The only part that's different is that they no longer needs a doctor's visit once a year (or less) to renew the prescription.

What we need is an end to the artificially long copyright protection period and we need drug price regulation like other countries have. When we travel we can buy US prescription drugs for much less in other countries than we can in the US.

[Lydia Leftcoast]

29. The price did go down

but only to about half of what it used to be, which was pretty outrageous.

Before Claritin went OTC, I was on Allegra, which is slightly cheaper than Claritin. However, for all the talk of high drug prices being necessary for funding the development of new drugs, the price of a month's supply of Allegra rose from $53.00 to $85.00 over a period of three years. (My health insurance plan had no drug coverage.)

When Claritin became available for $30.00 for a month's supply, you'd better believe I switched.

[tom_paine]

24. No way!

I'm no prude, but I don't think it is wise for anyone to be allowed over-the-counter access to Ritalin or Digitalis or Insulin.

I don't ooften say this, but that's crazy talk.

:silly: :crazy:

[SPAZtazticman]

26. the drug companies take the biggest cut

and what you are suggesting does not take them out of the picture. In addition, there is a big difference between legalizing recreational drugs and medicinal drugs. the difference is fairly simple: medicinal drugs are used for MEDICAL purposes!! therefore, dont you think its a good idea if someone who's had training in MEDICINE was involved somewhere along the line?

[arendt]

27. Why not eliminate medical licenses? Let anyone do brain surgery! ...

I mean, it worked in "Neuromancer", where people
"downloaded pirate Chiba med-tech" and operated
on themselves. :-)

You are a master of "the thin edge of the wedge". This is
classic Libertarian "reasonableness" (sic). I really don't
know why you bother to post this propaganda and flame-
bait on DU.

Here is why this idea is positively HOMICIDAL.

It costs literally hundreds of billions of dollars to prove
that drugs are safe IF, AND ONLY IF, TAKEN AS PRESCRIBED
FOR SPECIFIC CONDITIONS UNDER DOCTOR'S SUPERVISION.
They work for some people, some times, in some states of
health and/or disease. And oftentimes, it literally takes a Ph.D.
to figure out when that applies.

We already have the drug companies pushing drugs in
the media - "Tell your doctor you want XXX." - like the
stuff was a brand of corn flakes. That is already bad enough.
It overloads the doctors with harmful requests that,
at minimum, could damage the doctor/patient relationship
and thereby endanger the health of the patients. The
abuse of antibiotics is only the most visible problem here.

The typical retiree has to manage upwards of five medications
a day, with DRUG INTERACTIONS that are so complex it takes
competent professionals to sort out.

Now, you want to let people mix these things up in a blender,
like some fancy Long Island Iced Tea. It is medical nonsense.

Just what do Libertarians have against legitimate professional
control over dangerous substances?

File this idea under DEAD stupid.

arendt

[Snow]

32. You're a bit exuberant in making your point, and i'd like to

suggest a couple of counter-points. First, no one who's posted yet seems to know of how this all works or doesn't work in countries that do not restriction medications or drugs. I don't know what Korea does now, but when I lived there in the early 70's there were no prescriptions in the sense that while a physician could and usually would recommend you take such-and-so meds, you could go and buy it yourself without the piece of paper from the doc. The only practical bad outcome I saw was a lot of antibiotic resistance, and since I was working in tuberculosis control at the time, that was what I was most concerned about. I did not see greatly increased ER usage from improper med use - Koreans tend to be pretty conservative about medications in any event - but pharmacists were quite proactive about warning customers about the meds. At that time pharmacies were usuall mom-and-pop operations, but a pharmacist was trained and licensed pretty much as in the US. In all honesty I don't know what the situation was with opiates and other big scary drugs. I suspect that it was pretty straightforward to buy some pretty strong painkillers, but I don't know for sure.

On the matter of OTC drugs in the US, I don't see a lot of rationale to what stays on scrip and what's OTC. For a very small gap between the clinically effective dose and the lethal dose, it's hard to beat acetominophen/paracetomol. And you don't even have to mix it with any other prescription med to get potentiation of the dose - if you mix it with alcohol you can wipe out your liver very completely. And given that this is often taken for hangovers......
And our old friend aspirin along with the other NSAID's (non-steroidal anti-inflammatory drugs) together cause more deaths yearly in the US from gastrointestinal bleeds than all the deaths from HIV/AIDS! Nasty stuff, eh?

[McDiggy]

33. no.

Antibiotics NEED to be controlled. If someone takes them while not needed or doesn't take them long enough, the organism making them sick will build a resistence, thus rendering that antibiotic useless and unleashing a very, very bad strain of whatever-it-is into the public.

Then there are some things that are just flat out dangerous if not monitered. Take Comadin for example. It is a blood thinner. It is also rat poison. This isn't something that should even be given an opportunity to be screwed up. If a person that should be on 1mg of the stuff buys 10mg by accident, the consequences could be fatal.

[Snow]

40. I think that was my point, McDiggy,

that while the antibiotics were OTC, I saw a lot of resistance, and that of course was problematic in treatment. On the other hand, there's a ton of antibiotic resistance in this country, and where does that come from (said he rhetorically). Well, there's the whole animal feed story, already been mentioned - but just to add to that, antibiotics in feed is mostly for places like feed lots, swine confinement, chicken confinement facilities. Such facilities also are remarkably good at producing things like toxigenic e. coli outbreak potential. Let the beasts have more space!
Back on topic, docs also have had problems with overuse of antibiotics - for years it was the rule for any mother with a small child with an earache. My doc's second reaction when I develop a sinus inflammation is antibiotics - is she right? Dunno, the sinusitis goes away, but was there anything in there that needed killing? Anyway, you don't need to be in a place where the meds are all OTC to run into serious problems with antibiotic resistance, and we're beginning to have some scary problems with multi-resistant strep & staph strains that can't even be killed with vancomycin - this is a hospital infection control officer's nightmare.

[zoidberg]

34. Hardly flame bait!

I gave a rational proposal, suggested why it might be a good idea, acknowledged that there were many problems, and asked for input. If that's flame-bait, then screw it. I'll just start posting about missiles flying into the Pentagon.

To address your point: If somebody wants to make a Tropicana Twister of drugs, then let them go ahead and do it. They can go to the CVS right now and find a combination of things that will kill them for less than $20 now. The majority of people will still go to doctors or clinics to get medical advise. But now they wouldn't have to. If the retiree can't figure out how to take the five drugs without medical help, then let him get medical help. Nobody is saying he still wouldn't be able to go to the doctor.

To address a recurring theme: The point about anti-biotics is very valid, and the external costs of taking a drug should be taken into account when limiting what is available at will to the public. So you can only get anti-biotics with a prescription. Everything else is fair game.

[JasonBerry]

36. NO! Benzo Troubles.....

Valium, Xanax, etc. have RUINED many lives. Talk to anyone who has been through benzo (tranquilizer) withdrawal and they'll tell you what the deepest, darkest parts of HELL are like. And with tolerance, most people on tranqs don't realize the very symptoms that were supposed to be helped by these drugs are being WORSENED by them!

http://www.benzo.org.uk/

[Snow]

37. Very true, but

there is a very legal easily obtainable benzodiazepene equivalent, good old alcohol, which hit exactly the same brain receptors as the "booze in a pill" benzo family.

[JasonBerry]

38. That is true - BUT

People generally know what alcohol can do to them - with benzos it is usually "addiction by prescription." In other words, finding yourself in trouble unawares. It is a scandal. If they were available over-the-counter, the commercials would all push how they'll "settle the nerves" without a word about the HELL of withdrawal - documented worse than heroin.

[theboss]

41. Absolutely not

For all the reasons cited.

1. People need guidance in taking the stronger medication. I mean, morphine would make every condition "feel" better, but it wouldn't cure anything.

2. Abuse of antibiotics leading to drug-resistant strains.

3. Addiction.

And this is different from "legalizing" drugs. I support legalizing marijuana (though not necessarily "hard" drugs). The difference is alcohol and marijuanas only real purpose is recreational. Most pain killer addicts begin taking the medicine for legitimate reasons before sinking into addiction. I can only imagine the disaster if this was unregulated.

[sweetheart]

42. make formal approval optional

I interpret the first amendment right to free speech and religion as the free right to take whatever food/chemical as one wishes.

Given that, the FDA system was created to oppose quakery and dangerous marketing.

My answer: "caveat emptor" (buyer beware). You should be able to buy all and any medicine at quantities reasonable for your own usage... but if you want an FDA approval and a doctor's note, then certainly you'll pay more. Let the consumer choose.

I already know my contact lens perscription, my athsma medication preferences and which antibiotics work for me when i feel certain symptoms. I know my body better than any doctor.

Let me choose whether to engage the established doctor expensive system, or the real-life economic reality. Right on, zoidberg.... but then again, what else would one expect from a libertarian.. ;-)

[zoidberg]

44. Damn - I had forgotten about contact lenses

That's the biggest scam going right now. The machine tells you your prescription and the tech does all the work, but some damn fool doctor still has go through his lame 'first or second' routine to give you a note to get contacts.

[slappypan]

45. you have benefited from 70 years of regulation

You have reaped all the benefits of 70 years of FDA regulations, mandatory safety testing, government-funded medical research, and law enforcement efforts against dangerous fraud, and now you want to opt out of paying, because you feel you have what you need. The "real-life economic reality" is that all of the medical system that makes your life so comfortable is a result of government regulations and government infrastructure.